Percutaneous Heart Valve Replacement

In 1954, Charles Hufnagel, Proctor Harvey, and col-leagues1 published their classic description of the firsteffective surgical treatment of end-stage aortic insuffi-ciency, or indeed of any form of advanced valvular insuffi-ciency. First at the Peter Bent Brigham, they had worked long on the matter, later moving to Georgetown University Med-ical Center. There they developed a clever and elegantly simple approach to the task of supporting the overloaded left ventricle within the particular anatomic and physiological allowances of valvular aortic insufficiency. The challenge, which was met with gratifying effectiveness, was to interrupt the aortic outflow without the benefit of circulatory support machinery not then available, and to then interpose a pros-thetic valve at a point where regurgitant flow could be arrested. The now famous solution was to accept a remedy not entire, interrupting the aorta distal to the left subclavian artery. As the flow to the arch vessels was not interrupted, the